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Sudden Cardiac Death in College Athletes
A recent paper on the incidence and causes of death in NCAA athletes over the past two decades made me Stop and Think about making causal connections from anecdotes.
I had thoughts. Maybe you did too.
There were just so many media reports of cardiac arrest in athletes.
This is a column about two things—a medical problem (cardiac arrest) and the way our brains work.
During the pandemic we learned that the vaccine against SARS-CoV-2 could cause myocarditis—or inflammation of the heart. Young males had the highest risk of this adverse effect.
This was neither a welcome finding nor was it a common adverse effect. But it was real. Everyone now agrees. Also well known—from old data—was that myocarditis is a cause of cardiac arrest during sport.
So. When media reports during the pandemic told the dramatic stories of athletes having cardiac arrest, my brain started making causal connections…between a) the fact that most athletes had to take a mRNA vaccine, b) the vaccine could cause myocarditis, a cause of cardiac arrest, c) young athletes, mostly male, had the highest risk of vaccine-related-myocarditis, and d) there sure seemed to be a lot of these media reports.
The cardiac arrest of the famous Danish football star Christian Eriksen added a mental glue to these connections. His cardiac arrest occurred months after the vaccine was released in 2021. There was initial speculation that he had received a vaccine. The director of the team then said that Eriksen was not vaccinated. He is now back playing professional football—with an ICD.
Maybe it was my curated news feeds, but I saw media report after media report of athletes having cardiac arrest. I started to think. Well. That seems like some-thing is going on.
The problem with media reports is that anecdotes do not sum up to data. And now we have some systematic data.
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A carefully done paper presented at the recent AHA meeting and published in Circulation found no increase in sudden cardiac death in NCAA athletes. In fact, the authors reported a decline in sudden cardiac death during the years 2021-2022.
This was a 20-year survey in which the authors used 4 independent databases to document the incidence and causes of sudden cardiac death in NCAA athletes.
They found 143 cases of sudden cardiac death over the 20 years. The overall incidence of SCD was 1:63,682 athlete-years, which is inline with published incidence rates from other studies.
Here are the plots of incidence rates over time. You can see a clear decline in the rates over the years. The last two years are the lowest. (Red line.)
The authors also looked into causes of these deaths—a more difficult task. A cause of death could not be determined in 17% of cases.
The most common postmortem finding was “autopsy-negative” sudden unexplained death. This means the heart looked normal on exam. This picture shows the other common causes of death from the autopsy.
Notably, the authors reported only one case of myocarditis-related death during the 2020-2022 period.
The authors acknowledge limitations. The main one I think is the absence of data on resuscitated arrests. This is important because of the positive trend of increased availability of automatic external defibrillators or AEDs. Namely, it’s possible that there was an increase in cardiac arrests, but not cardiac death—due to better interventions. (In fact, the lower incidence of sudden death in recent years is likely to be due to AEDs).
What I took from this study is to remain vigilant about making causal connections without proper data. Gosh, it seemed like a lot of media reports.
I wasn’t the only one having these thoughts. I recently did a podcast with electrophysiologist Paul Dorian on Sensible Medicine in which we discussed the causes of cardiac arrest in athletes. The post received more than a 100 comments; many writers criticized us for not mentioning vaccine-related arrests.
Yet the lack of any signal of increased sudden cardiac death among NCAA athletes is reassuring. It argues against the idea that mRNA vaccines was causing excess cardiac deaths in young athletes.
This doesn’t mean mandating the SARS-CoV-2 mRNA vaccine in some of the lowest risk groups was a wise decision. In my opinion, the downplay of the myocarditis signal from the vaccine as well as the mandates shredded public trust. It’s a mistake I hope medical leaders learn from.
Yet this study again confirms that anecdotes don’t always sum to evidence. And it is wise to make note of how easy it is for our brains to find causal connections.
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